Our aim was to identify key prognostic factors for recurrence and progression of upper tract urothelial carcinoma (UTUC) after endoscopic kidney-sparing surgery (eKSS), and to provide a reliable, easy-to-use, risk stratification model.
We used data from a retrospective multicenter database for 358 patients with UTUC who underwent eKSS with curative intent between 2010 and 2021. A scoring system to predict recurrence-free survival (RFS) and progression-free survival (PFS) was developed using regression analyses. The discriminative ability of the score was estimated using the C index.
The analysis included 223 patients, of whom 106 (48%) had recurrence and 37 (17%) had progression at median follow-up of 39 mo. Scoring systems were created that included synchronous bladder cancer (BCA; hazard ratio [HR] 1.52), high grade at biopsy (HR 1.38), multifocal UTUC (HR 1.12), and history of UTUC (HR 1.43) as factors for RFS, and synchronous BCA (HR 1.44), high grade at biopsy (HR 1.38), size ≥2 cm (HR 1.23), and positive cytology (HR 1.64) as factors for PFS. The C index was 0.60 for 5-yr RFS and 0.64 for 5-yr PFS. Three risk groups for each model were identified. The 5-yr cumulative incidence rates for the low-risk, intermediate-risk, and high-risk groups were 37%, 58%, and 70% for recurrence, and 4%, 18%, and 30% for progression, respectively. Limitations include the lack of external validation, a heterogeneous eKSS cohort, and limited follow-up.
We propose a novel risk stratification model for patients with UTUC treated with eKSS that includes key predictors for recurrence and progression and an intermediate-risk UTUC category with distinct outcomes.
European urology oncology. 2026 Jan 24 [Epub ahead of print]
Andrea Gallioli, Francesco Di Bello, Fabio Zattoni, David D'Andrea, Ekaterina Laukhtina, Francesco Soria, Luca Afferi, Francesco Del Giudice, Wojciech Krajewski, Gautier Marcq, Elisa De Lorenzis, Marco Moschini, Andrea Mari, José Daniel Subiela, Isacco Donnini, Lucía Diéguez, Paula Izquierdo, Benjamin I Chung, Giulio Avesani, Angelo Territo, Giuseppe Basile, Joan Palou, Benjamin Pradere, Alberto Breda, European Association of Urology Young Academic Urologists Urothelial Working Group
Department of Urology, Fundació Puigvert, Barcelona, Spain; Department of Surgery, Autonomous University of Barcelona, Barcelona, Spain; Institut de Recerca Sant Pau, Barcelona, Spain., Department of Urology, Fundació Puigvert, Barcelona, Spain; Department of Surgery, Autonomous University of Barcelona, Barcelona, Spain; Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples "Federico II", Naples, Italy. Electronic address: ., Urologic Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, Turin, Italy., Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland; Department of Urology, Kantoonsspital Aarau, Aarau, Switzerland., Department of Maternal Infant and Urologic Sciences, Sapienza University of Rome, Policlinico Umberto I Hospital, Rome, Italy; Department of Urology, Stanford University School of Medicine, Stanford, CA, USA., Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, Wroclaw, Poland., Department of Urology, Claude Huriez Hospital, Lille, France., Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Department of Urology, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy., Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy., Department of Urological Robotic Surgery and Renal Transplantation, University of Florence and Careggi Hospital, Florence, Italy., Department of Urology, Instituto Ramón y Cajal de Investigación Sanitaria, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain., Department of Urology, ASST Spedali Civili, University of Brescia, Brescia, Italy., Department of Urology, Fundació Puigvert, Barcelona, Spain., Department of Urology, Stanford University School of Medicine, Stanford, CA, USA., Department of Urology, Fundació Puigvert, Barcelona, Spain; Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy., Department of Urology, Urosud, La Croix du Sud Hospital, Quint Fonsegrives, France.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/41582026